JAY® X2
Cushion
March 2014
SUBMIT
Mark For:
Submitting for:
Date:
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ADDITIONAL SHIPPING INFORMATION
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ST:
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Confirmation Email:
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The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.
The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy.
Actual
HCPCS
Option #
Definition
Width
Depth
Price
14"
16"
15"
16"
16"
17"
18"
20"
16"
17"
16"
18"
20.25"
20"
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
$425.00
JAY X2 Size Matrix
JAY X2 CUSHION Less then 22" in Width (300lb weight capacity)
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
E2622
JAY X2 Cushion 14" X 14"
JAY X2 Cushion 14" X 16"
JAY X2 Cushion 15" X 15"
JAY X2 Cushion 15" X 16"
JAY X2 Cushion 16" X 16"
JAY X2 Cushion 16" X 17"
JAY X2 Cushion 16" X 18"
JAY X2 Cushion 16" X 20"
JAY X2 Cushion 17" X 16"
JAY X2 Cushion 17" X 17"
JAY X2 Cushion 18" X 16"
JAY X2 Cushion 18" X 18"
JAY X2 Cushion 18" X 20"
JAY X2 Cushion 20" X 20"
13.75"
13.75"
15.25"
15.25"
15.75"
15.75"
15.75"
15.75"
17.25"
17.25"
17.75"
17.75"
17.75"
19.75"
WIDTH
N/A JYW JYW JYW JYW JYW JYW N/A
N/A
N/A
N/A
N/A JYW JYW JYW JYW JYW JYW N/A
N/A
N/A
N/A
N/A JYW
JYW JYW JYW JYW N/A
N/A
N/A
N/A
JYW JYW JYW N/A
N/A
N/A
N/A
JYW JYW N/A
N/A
JYW JYW JYW N/A
N/A
N/A JYW JYW
DEPTH
JX21414
JX21416
JX21515
JX21516
JX21616
JX21617
JX21618
JX21620
JX21716
JX21717
JX21816
JX21818
JX21820
JX22020
N/A JYW
N/A
N/A
N/A JYW
N/A
N/A
N/A JYW
JYW JYW N/A
N/A
N/A
N/A
N/A JYW JYW JYW JYW JYW JYW N/A
N/A
N/A
N/A
N/A JYW
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
JYW
N/A
JAY X2 CUSHION with Extra Cover - Less then 22" in Width (300lb weight capacity)
JX21414-2
E2622 JAY X2 Cushion 14" X 14"
13.75"
14"
JX21416-2
E2622 JAY X2 Cushion 14" X 16"
13.75"
16"
JX21515-2
E2622 JAY X2 Cushion 15" X 15"
15.25"
15"
JX21516-2
E2622 JAY X2 Cushion 15" X 16"
15.25"
16"
JX21616-2
E2622 JAY X2 Cushion 16" X 16"
15.75"
16"
JX21617-2
E2622 JAY X2 Cushion 16" X 17"
15.75"
17"
JX21618-2
E2622 JAY X2 Cushion 16" X 18"
15.75"
18"
15.75"
20"
JX21620-2
E2622 JAY X2 Cushion 16" X 20"
JX21716-2
E2622 JAY X2 Cushion 17" X 16"
17.25"
16"
JX21717-2
E2622 JAY X2 Cushion 17" X 17"
17.25"
17"
JX21816-2
E2622 JAY X2 Cushion 18" X 16"
17.75"
16"
JX21818-2
E2622 JAY X2 Cushion 18" X 18"
17.75"
18"
JX21820-2
E2622 JAY X2 Cushion 18" X 20"
17.75"
20.25"
JX22020-2
E2622 JAY X2 Cushion 20" X 20"
19.75"
20"
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
$525.00
=
=
=
JYW
JYW
JYW
Standard Offering
Offered Via Jay Your Way
Not available
JAY X2 Measuring Guide
Measurements made from completed cushion with covers.
X"
Width
Y"
X = Width
Note: Measurement made
from rear bottom edge to
bottom edge of the cushion.
Ex: JX21618 X=16"
Depth
Bottom View
Y = Depth
Note: Measurement made
from front edge of rear cutout
and front lower of cushion.
Ex: JX21618 Y = 18"
JAY YOUR WAY MODIFICATIONS - Please refer to the "JAY YOUR WAY" product catalog for complete listing of modifications
Note: To order sizes offered via JAY Your Way add a "M" to the front of the part number and follow the prompts.
Active Fluid Bladder
Size Change
AFB
$125.00
Active Fluid Bladder
Notes: 40% Larger fluid bladder that provides fluid support to the outside edges of the cushion.
IL
Increase Length - NOT AVAILABLE
RL
Reduce Length
Fluid Volume Change
OF
5%
-1"
Fluid Volume Overfill
10%
15%
UF
20%
25%
30%
35%
Fluid Volume Underfill
-5%
-10%
-15%
5%
10%
15%
OOFL
IW
Increase Width - NOT AVAILABLE
N/A
RW
Reduce Width
NC
5%
20%
10%
OUFR
15%
20%
NC
25%
30%
35%
40%
NC
25%
30%
35%
40%
NC
Obliquity Underfill - Right Side
-5%
OUFL
-10%
-15%
Obliquity Underfill - Left Side
-5%
-10%
-15%
Add Positioning Components
Don't see the option you want? NO PROBLEM! Write your request below and we can
evaluate it and provide a quote.
Notes:
-20%
Please visit www.sunparts.us for spare parts information.
Incontinent
NC
Notes: Add 1" tall Lateral, Medial, and Pelvic Positioning Pieces.
NC
Cover Options
X-static w/ Stretch
Positioning Components
-20%
NC
Cover Options
CVR
-1"
APC
Obliquity Overfill - Left Side
-4"
NC
-20%
Obliquity Overfill - Right Side
NC
-3"
40%
NC
Obliquity Fluid Volume Change
OOFR
-2"
N/A
Microclimatic
Customer Service: 800-333-4000 Fax: 800-300-7502 Email: [email protected] www.sunrisemedical.com
Specifications are subject to change without notice. Copyright © 2014 Sunrise Medical (US) LLC. X2 Cushion Mar 2014, 127757 REV. B
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